Although great advances have been made in the clinical understanding of trachoma, the disease remains endemic in many parts of the world. Economic, environmental, cultural and behavioral factors continue to play an important role in trachoma transmission and progression. The trachoma literature however, contains relatively few studies which rigorously assess the importance of social factors. A critical review of the trachoma literature implicates individual and community hygiene as important risk factors for disease. Specific risk behaviors remain to be identified and validated as independent predictors of infection in different settings. Collaboration between biomedical and social science professionals is needed to design and carry out further research.